STANDARD OF MEDICAL AND HEALTHCARE PRACTICES

Dr Lily Neo asked the Minister for Health if his Ministry will take steps to allay the fears of the public and reassure them that we have (i) first-world standard of medical and healthcare practices; and (ii) effective regulatory bodies in place to ensure transparent audit and inquest of medical errors or negligence.

The Minister for Health (Mr Lim Hng Kiang): Mr Speaker, Sir, Singapore has achieved a high standard of medical practice by:

(a) providing a comprehensive network of well-equipped and accessible health care facilities;

(b) ensuring our health care professionals are well-trained and qualified through a well-established system of statutory registration and accreditation;

(c) ensuring that clinical practice is evidence-based and benchmarked with current best practices; and

(d) enforcing compliance with standards through the licensing of all health care establishments.

The high standard of medical practice in Singapore is well reflected in the good outcomes of medical care we have achieved which are comparable to the best medical centres in the world. We track benchmark performance indicators regularly. For example, our mortality rate for cardiac bypass surgery is 0.8% which is comparable to the rate of 1% in major cardiac centres in the US.

A key component of the tracking and regulatory system is the National Medical Audit Programme (NMAP) implemented since July 1998 for all acute hospitals. The NMAP is the framework for comprehensive monitoring and evaluation of clinical outcomes. From the NMAP, we can obtain a comparative assessment of the clinical performance indicators of our acute hospitals. The NMAP also monitors critical quality assurance processes in the hospitals such as infection control, review of tissues removed at operation, review of complications of interventional treatment, in-patient deaths, adverse drug reactions, audit of post-operative complications, and the audit of ICU care, Through these quality assurance processes, potential medical errors are detected and investigated.

Any death resulting from medical treatment is reported to the Coroner for thorough investigation. Inquiries held by the Coroner are open to the next-of-kin of the deceased. Any person found criminally negligent for the death will be liable for criminal prosecution.

The hospitals are required to conduct a Committee of Inquiry to investigate any adverse event arising from the management of a patient, eg, severe adverse drug reactions. The objective of the Inquiry is to determine if the patient had been managed correctly, and to recommend measures to prevent the recurrence of any deficiency detected.

My Ministry will appoint external audit committees from its panel of medical expert advisors to investigate and review deaths and serious incidents due to medical errors. This will ensure that we learn from our mistakes and prevent a recurrence.

Where there is professional misconduct associated with a medical error, the disciplinary process is undertaken by the Singapore Medical Council. The process is retransparent, thorough and objective.

To summarise, the current standards of medical practice in Singapore are comparable to reputable centres overseas. Medical errors resulting in deaths and serious injuries here are rare, but when they occur there is an effective and objective system to ensure that such errors are adequately investigated and steps are taken to prevent future occurrence.

Dr Lily Neo (Kreta Ayer-Tanglin): Sir, may I ask the Minister how many deaths were there in Singapore in the past 10 years due to medical errors, and how many doctors were implicated as negligent?

Mr Lim Hng Kiang: Sir, I am sorry I do not have the numbers here. I will send the numbers to the Member.

Dr Lily Neo: May I ask the Minister whether he would consider mandatory reporting to the Ministry of Health by doctors on all medical errors including near misses, with the assurance from the Minister that this is a matter of investigation so that certain improvements could be made to correct any individual or system deficiency, and not for litigious proceedings?

Mr Lim Hng Kiang: Sir, as I have explained in my answer, there is a comprehensive system for reporting and follow-up investigation. We do this in a very comprehensive way under the medical audit programme. So this is already in place and any medical errors are reported and investigated.

Dr Lily Neo: Sir, with due respect, we do not have any system that requires all doctors to report medical errors, especially near misses.

Mr Lim Hng Kiang: It is a question of definition. Our processes, as I have explained in my answer, cover investigation of all the tissues which are taken out during an operation, it also covers any severe adverse drug reactions. These are the key areas where medical errors can occur, and all these are followed up.

As regards "near misses", it is a question of how one defines a "near miss". Medicine is not pure science. It is both science as well as art. You act based on the information available at that time. Post-operation, you may discover that there were other information which were not available. So hindsight is always 20 upon 20.

Sir, I think we have in place a comprehensive system. If the Member has any further suggestions of how we can improve, we will be very happy to look at these suggestions.